Recent Changes

Sunday, May 20

  1. page Whole Body Bone Scan edited ... Have you had an recent abnormal blood work? Have you had any recent dental work? Comments: …
    ...
    Have you had an recent abnormal blood work?
    Have you had any recent dental work?
    Comments:
    I noticed at BMC that bone scans differ from the protocol we learned in class.
    -Use MDP only not HDP
    -Use 25 mCi for everyone (except peds.)
    -Wait 3 hours for delays
    -Encourage patients to drink 3 cups of water minimum
    -SPECT first for CA protocol for prostate CA patients because this is when the bladder will be the most empty
    -Use a scan speed of 10 cm/min

    References:**
    image from abnormal uptake-->
    (view changes)
    11:13 am

Thursday, April 26

  1. page Scintimammography edited ... Statics: View(s) Matrix: 256 x 256 ... Counts or Duration:5 Duration:10 min per Whole …
    ...
    Statics: View(s)
    Matrix: 256 x 256
    ...
    Counts or Duration:5Duration:10 min per
    Whole body: View(s)
    Matrix:
    ...
    Procedure:
    Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.
    ...
    as well.
    Normal Uptake and common varients:
    Insert an image of a normal scan. Describe the normal uptake, and any normal varients visualized.
    (view changes)
    2:01 pm
  2. page Scintimammography edited ... Procedure: Describe the procedure from verifying the requisition to completing the scan. Incl…
    ...
    Procedure:
    Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.
    Explain the procedure to the patient and make sure to check if the patient has had any recent mammograms. Inject the patient with 20-30mCi of Tc-99m Sestamibi into the dorsal foot to decrease chance of false-positive lymph node presentation; after 10 minutes, begin imaging 10minutes images. Make sure that the patient is in a prone position with arms over their head, and place a lead shield in between the breasts to eliminate the possibility of counts coming through from one breast to the other during imaging. Place camera head as close as possible to the side of the patient's breast. After each lateral image, an optional anterior image can be taken under the table if desired/necessary. Lastly, obtain 30 degree posterior obliques with the patient's arms up for 10minutes for each image as well.
    Normal Uptake and common varients:
    Insert an image of a normal scan. Describe the normal uptake, and any normal varients visualized.
    (view changes)
    1:59 pm
  3. page Lung scan with Quantitative analysis edited ... Side Effects: Will the patient feel any different during or after the procedure? None Equ…
    ...
    Side Effects:
    Will the patient feel any different during or after the procedure?
    None
    Equipment Used:
    Type of Camera:Large field of view
    ...
    Matrix:
    Total Counts or Duration: Perfusion - 500-750kcts
    Whole body: View(s)
    Matrix:
    Scan Speed:
    Start/stop points:

    SPECT:
    180 or 90 degree configuration
    Total

    Total
    Rotation: 180 or 360
    Starting point: 0
    Matrix:
    Time/Azmuiths
    Number
    64x64
    Time/Azmuiths: 17sec/azimuth
    Number
    of Azmuiths: 64
    Processing:
    Filter: Butterworth
    Cut-off: 6
    Frequency: 0.35
    Procedure:
    Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.
    Explain the procedure to the patient and confirm that they have had a chest x-ray done before performing the next set of studies. If possible, ask the patient to cough and take a couple deep breaths. After making sure that the patient is supine, inject 4mCi of Tc-99m MAA into patient intravenously, making sure that the camera begins imaging a couple seconds before injection and also, not to draw back blood into the syringe because that would cause "clumping" and hot spots would appear in the images. Make sure to get 500k-750k counts for each image; image anterior, posterior, laterals, anterior and posterior obliques. A SPECT could also be done after the perfusion.
    After the perfusion scan, a possible ventilation scan may need to be performed. The ventilation scan can be done either with a radioaerosol or radioactive gas. The purpose is to compare the radioaerosol or radioactive gas image with the perfusion images and see if there is a mismatch between the two.
    Radiactive Gas: Place the gamma camera behind the patient and move the camera face right onto the surface of their back. Make sure that the room that this procedure is done in has a negative pressure and has the ventilation system on the floor of the room. Place a marker over the suprasternal notch and make sure that that lungs are completely in the field of view. After explaining the procedure to the patient, ask the patient to breath out completely, and then place the mask onto the patient's face; ask the patient to take in a deep breath and then start imaging. There are three phases necessary for this test: the initial breath that lasts 10-15seconds, equilibrium phase that lasts 2seconds (1sec/frame for 2 frames) and washout that lasts 10-15seconds.
    Radioaerosol: Patient can be either supine or upright for this procedure. This procedure utilizes a nebulizer that contains an injected 30-40mCi of Tc-99m DTPA. Explain the procedure to the patient, and place a noseclamp onto the patient to decrease likelihood of the radiotracer escaping. Have the patient put the mouthpiece into their mouth and ask them to breath normally for approximately 5minutes. After 5 minutes, remove the mouthpiece and nose plug and beging obtaining anterior, posterior, laterals, and obliques for anterior and posterior for 250k counts each.

    Normal Uptake and common varients:
    Insert an image of a normal scan. Describe the normal uptake, and any normal varients visualized.
    (view changes)
    1:45 pm
  4. page ACE-inhibitor renal scan edited ... Number of Frames: 60 frame Statics: View(s) Matrix: 256 x 256 Total Counts or Duration: …
    ...
    Number of Frames: 60 frame
    Statics: View(s)
    Matrix: 256 x 256
    Total Counts or Duration:
    Whole body: View(s)
    Matrix: NA
    Scan Speed: NA
    Start/stop points: NA
    SPECT:
    180 or 90 degree configuration
    Total Rotation: 180 or 360
    Starting point:
    Matrix:
    Time/Azmuiths
    Number of Azmuiths:
    Processing:
    Filter:
    Cut-off:
    Frequency:
    Pre-void 500k cts and post-void 500k cts
    Procedure:
    Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.
    (view changes)
    12:02 pm

Tuesday, April 24

  1. page Flow and Function Renal Scan edited ... Radiopharmaceutical information: Radionuclide: Tc-99m or I-131 Radiopharmaceutical: Tc-99m …
    ...
    Radiopharmaceutical information:
    Radionuclide: Tc-99m or I-131
    Radiopharmaceutical: Tc-99m MAG3MAG3, Tc-99m DTPA, Tc-99m GH
    Adult dosing: 3-5 mCi
    Tc-99m MAG3: 3-5mCi
    Tc-99m DTPA: 15mCi
    Tc-99m GH: 20mCi

    Pediatric dosing: 100 uCi
    Method of administration: Bolus injection
    Method of Localization: active transport
    ...
    Half-life: 6 1/2 hrs
    Patient Preparation:
    Identify the patient (name and DOB)
    Explain the procedure to the patient
    ...
    to hydrate and void(300-500mL of water)
    Void
    before the
    Have the patient stop any diuretics that he or she is taking
    have the patient wear comfortable clothing with no metal or a gown
    ...
    LEHR
    Acquisition Setup:
    Photopeak(s): 140 KevkeV
    Window(s): 25%
    Dynamic: View(s)

    Blood Flow: View(s): native kidney: posterior, transplant kidney: anterior

    Matrix:
    64x64
    64x64
    Time/Frame:
    1-2 sec/frame for
    1-2 seconds/frame
    Number of Frames or Duration:
    60 secseconds
    Dynamic: View(s):
    native kidney: posterior, transplant kidney: anterior
    Matrix: 64x64
    Time/Frame: 30 seconds/frame

    Number of Frames:
    30-60 frames
    Frames or Duration: 25 minutes
    Statics: View(s)View(s):
    pre-void and post-void

    Matrix:
    64x64
    64x64
    Total Counts or Duration:
    30 sec/frame for 25-30 min
    500k counts/image
    Whole body: View(s)
    Matrix: N/A
    ...
    If there are any defects in the patients kidneys such as horseshoe kidney, pelvic kidney, polycystic disease, ileal loop, any masses that may change the position of the kidney, or foreshortening position the camera so that it faces anterior to the kidneys.
    Prepare the MAG3 injection
    Start up the camera
    Immidietly

    Immediately
    after you start upstarting the cameracamera, bolus the
    If bolus is is good the slope of you time activity curve should be steep, no activity persisting in the heart and lungs, and immediate visualization of the kidneys should be present.
    Image as soon as you see abdominal aortic uptake within 2-5 sec of the bolus injection
    At the 1-3 min marker paraenchymal tissue will be visualized
    Aquire dynamicAcquire blood flow images 1-2
    ...
    the kidneys
    After the dynamics aquire statics for 30/frame for

    Immediately after acquiring blood flow, begin dynamic imaging
    30 minin ordersec/frame for 25 minutes to visualize renal clearance
    Obtain pre-void and post-void statics of 500k counts each.

    Analyze the TAC (time activity curve) to observe the renal flow and function.
    ...
    you a 60-40%60:40 renal function
    ...
    slopes that looks like they steep uppeak then go back downdown.
    An abnormal TAC would would foerfor example give you a 65-35%65:35 renal function
    ...
    functioning kidney would steep upwill peak and go
    ...
    slope would steep up and not go back downpeak and remain that wayway.
    Normal Uptake and common varients:
    {IMAG0001-1.jpg}
    (view changes)
    4:34 pm
  2. page Ga-67 for infection edited ... Start/stop points: SPECT: 180 circular or 90 degree configuration non circular orbit …
    ...
    Start/stop points:
    SPECT:
    180circular or 90 degree configurationnon circular orbit
    Total Rotation: 360
    Starting point:
    ...
    Insert an image with an artifact, and explain what the artifact is.
    {http://gamma.wustl.edu/ga001ga162.gif}
    ...
    previous chemotherapy.
    References:
    http://gamma.wustl.edu/ga001te162.html
    (view changes)
    3:54 pm
  3. page Lymphoscintigraphy edited ... Adult dosing: 4-6 (possible low of 1 or as high as 8) injections of 0.1 mCi per 0.1 ml, around…
    ...
    Adult dosing: 4-6 (possible low of 1 or as high as 8) injections of 0.1 mCi per 0.1 ml, around 0.4-1 mCi
    Pediatric dosing: 0.4-1.0 mCi
    Method of administration: intradermal/intracutaneous/subdermal injection with 25 gauge needles, inject peritumoraladministration:-Melanoma: 2-6 subcutaneous or periaereolar within 1 cmintradermal injections around cancer site, surgery, or region of the lesioninterest.
    -Breast lesions: 4-6 intradermal injections surrounding peri-tumoral
    or excisional biopsy site, 4 points in a clock formation,peri-aereolar tissue at 3-, 6-, 9-, and flush the injection12-o’clock positions around tumor site. Injections may be done under ultrasound to ensure the dose is out of the syringe.Youlocate tumor. You can massage
    ...
    injection site.
    Method

    -May include lidocaine or sedation to reduce pain of injections. Flush the injection to ensure the dose is out of the syringe.
    Method
    of Localization: compartmental, phagocytosis
    Physical Half-life: 6 hours
    Patient Preparation:
    ...
    Statics: View(s)
    Anterior, posterior, and lateral or oblique depending on injection location
    Matrix: 256x256256x256x16
    Total Counts or Duration: 5 minutes
    Transmission scan
    ...
    {F4.large.jpg}
    Swollen limb indicates impaired lymph drainage
    http://www.ajronline.org/content/197/6/1443.abstract
    Artifacts
    Insert an image with an artifact, and explain what the artifact is.
    ...
    References:
    "Lymphoscintigraphy." Web. <http://www.ctf.edu.tr/anabilimdallari/pdf/225/Lymphoscintigraphy.pdf>.
    Shackett, Pete. Nuclear Medicine Technology: Procedures and Quick Reference. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008. Print.
    [[include component="editors" days="7" imageSize="small" showUsername="true"]]
    (view changes)
    2:48 pm

Sunday, April 22

  1. page Flow and Function Renal Scan edited ... Pediatric dosing: 100 uCi Method of administration: Bolus injection ... of Localization: …
    ...
    Pediatric dosing: 100 uCi
    Method of administration: Bolus injection
    ...
    of Localization: Tubular secretionactive transport
    Physical Half-life: 6 1/2 hrs
    Patient Preparation:
    ...
    Abnormal Uptake and causes:
    {Renal_obstruction.gif}
    ...
    part 1)
    Artifacts:
    Insert an image with an artifact, and explain what the artifact is.
    (view changes)
    7:45 pm
  2. page Brain Perfusion edited ... Tissue Viability Cognitive Functions Stroke Dementia CVD Brain Death Epilepsy Movement…
    ...
    Tissue Viability
    Cognitive Functions
    Stroke
    Dementia
    CVD
    Brain Death
    Epilepsy
    Movement disorders
    Head Trauma

    Further Evaluation of the brain due to abnormal results from other studies
    Contraindications:
    If the patient is uncooperative and cannot keep their head still which will in effect cause artifacts in the final image and you could miss defects.
    ...
    the scan.
    Questions asked in Patient History:
    Can the sit still for 1 hour?
    (view changes)
    5:12 pm

More